MEDICARE: DR. MATTHEW J PITERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA05960500	NJ
2	2084P0802X	Addiction Psychiatry Physician	25MA05960500	NJ
3	2084P0804X	Child & Adolescent Psychiatry Physician	25MA05960500	NJ

General Provider Information

NPI Number	:	1225097702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J PITERA M.D.

Provider Business Mailing Address
First Line	:	2446 CHURCH RD
Second Line	:	SUITE 2-D
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753
Country	:	US
Telephone Number	:	732-244-6626
Fax Number	:	732-244-6623

Provider Business Practice Location Address
First Line	:	2446 CHURCH RD
Second Line	:	SUITE 2-D
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753
Country	:	US
Telephone Number	:	732-244-6626
Fax Number	:	732-244-6623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	12/13/2016

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